A history typical of Bell’s palsy with normal findings on examination does not warrant investigation immediately.

Most children presenting with uncomplicated facial nerve paralysis need no investigation.

However, there are exceptions. Some ENT and Haematological specialists recommend performing a full blood count with film in all cases at the outset to identify serious causes such as leukamia early [2,12].

Children with a history of travel to or living in an area where Lyme’s disease is endemic and a history of exposure to a tick prone environment such as field or forest, should have Lyme serology performed.

Lyme disease distribution can be found here.

Suggestive history, central or UMN CNVII palsy, other focal neurology peripherally, or other cranial nerve abnormality on examination should all prompt imaging. MRI is preferable for investigating a possible underlying neoplasm [1]; CT is preferable if an acute traumatic cause is suspected.

Formal follow-up is essential, irrespective of investigations performed. Nerve conduction studies, electromyography and electroneurography, and acoustic reflex determination (ipsilateral and contralateral) are not investigations required in the emergency department, however, these may have a role during follow-up [2].